Rosuvastatin is Stronger than Atorvastatin for LDL-C Reduction
Rosuvastatin is significantly more potent than atorvastatin at lowering LDL cholesterol on a milligram-per-milligram basis, with rosuvastatin 10 mg reducing LDL-C by 46% compared to 37% with atorvastatin 10 mg. 1
Comparative Potency by Dose
- At equivalent doses (1:1 dose ratio), rosuvastatin consistently demonstrates greater LDL-C reduction than atorvastatin across the dosing range 1
- Rosuvastatin 5 mg reduces LDL-C by approximately 45% compared to 39% with atorvastatin 10 mg 2
- Rosuvastatin 10 mg reduces LDL-C by 46% compared to 37% with atorvastatin 10 mg 1
- Rosuvastatin 20 mg reduces LDL-C by 52% compared to 43% with atorvastatin 20 mg 1
- Rosuvastatin 40 mg reduces LDL-C by 55% compared to 48% with atorvastatin 40 mg 1
- At maximal doses, rosuvastatin 40 mg reduces LDL-C by 63% compared to 51% with atorvastatin 80 mg 1, 3
Clinical Significance of Potency Difference
- The higher potency of rosuvastatin means that lower doses can be used to achieve similar LDL-C reductions compared to atorvastatin 2, 1
- Rosuvastatin enables more patients to achieve National Cholesterol Education Program (NCEP) goals for LDL-C at lower doses compared to atorvastatin 4
- For high-risk patients requiring intensive LDL-C lowering (≥50%), rosuvastatin 20-40 mg or atorvastatin 40-80 mg are both recommended options 2
- Meta-analyses show that rosuvastatin provides additional LDL-C lowering compared to atorvastatin at both 1:1 and 1:2 dose ratios without increased risk of adverse events 5
Effects on Other Lipid Parameters
- Rosuvastatin also demonstrates greater efficacy in raising HDL-C (approximately 10%) compared to atorvastatin (approximately 5%) 4
- Rosuvastatin 40 mg is more effective than atorvastatin 80 mg in decreasing small dense LDL (sdLDL) cholesterol (-53% vs -46%) 3
- Both statins have similar effects on triglyceride reduction 3
- Rosuvastatin more favorably modifies total cholesterol/HDL-C ratio, non-HDL cholesterol, and apolipoprotein B levels compared to equivalent doses of atorvastatin 6
Safety Considerations
- Both rosuvastatin and atorvastatin have similar safety profiles at comparable doses 5
- The risk of adverse events (myalgia, liver enzyme elevations, creatine kinase elevations) is not significantly different between the two statins 5
- No significant differences in serious adverse events or withdrawals due to adverse events have been observed between rosuvastatin and atorvastatin 5
- Both statins are well-tolerated in clinical practice at their respective doses 2
Clinical Application
- When selecting between these statins, consider that rosuvastatin provides greater LDL-C reduction at equivalent doses 1
- For patients requiring modest LDL-C reduction (30-40%), lower doses of either statin are appropriate, with rosuvastatin being more potent on a milligram-per-milligram basis 2, 7
- For patients with very high baseline LDL-C levels who need to achieve specific LDL-C goals, rosuvastatin may be preferred due to its greater potency 4, 6
- When maximum statin therapy is insufficient to reach LDL-C goals, combination with ezetimibe should be considered before increasing to maximum doses if there are tolerability concerns 2
Practical Considerations
- Both statins have different metabolism pathways: atorvastatin is primarily metabolized by CYP3A4, while rosuvastatin relies more on CYP2C9, which may affect drug interaction profiles 2
- Rosuvastatin has a longer half-life (19 hours) compared to atorvastatin (14 hours), which may influence the duration of any potential side effects 2
- For patients at high risk of statin-associated muscle symptoms (elderly, women, those of Asian descent), starting with lower doses of either statin is recommended 2
In conclusion, rosuvastatin demonstrates greater LDL-C lowering potency than atorvastatin at equivalent doses, making it the stronger statin for LDL-C reduction on a milligram-per-milligram basis.